Medical Schools' Role in Primary Care Shortage

We hear frequently these days about the looming physician shortage, which will be especially acute in rural and poor urban areas, and in primary care specialties (internal medicine, family medicine, obstetrics & gynecology). Yet unfortunately very little is being done to address the shortage, aside from research and conferences and publications telling us what we have known for some years. It is inevitable that at some point in the near future the collapse of primary care in this country will yield an angry reaction from the media and subsequent public outcry. Don't say us doctors didn't tell you.

The problem of why we are going to have a doctor shortage is multi-factorial, but starts with medical education. In short, medical schools are too restrictive (and expensive, but this is another topic). This shuts out many people who despite not being top-of-the-class would otherwise make fine doctors. In fact, it is well known in medicine that perfect grades and test scores are not accurate predictors of whether that person will be a good doctor. As much as our medical schools now try to fill their classes with students with diverse backgrounds, the fact remains that medical students are still a pretty uniclonal group. They all have extraordinary academic records and curriculae vita and tend to have backrounds in the so-called hard sciences. The fact that medical schools still select out these types of students demonstrates to me a startling inconsistency between what the medical profession knows (medicine is not science) and what the medical profession thinks is the best way to replenish its ranks (scientists make good doctors).

To illustrate this point consider psychiatry, the medical specialty with perhaps the largest supply-demand disproportion. This is not because there are simply too few people who want to be psychiatrists; there are many young college students who would jump at the chance to go to med school to become a psychiatrist if they had an opportunity. I am sure that we could easily eradicate the psychiatrist shortage in a few short years by gently easing the academic standard to enter medical school for those who would committ to going into that profession. I know many people would oppose this for fear that it would jeopordize the integrity of the profession, and they would be right if we lowered standards of personal integrity in order to graduate more psychiatrists. Being a person of high integrity, however, has nothing to do with getting straight As.

Medical school admits mostly highly ambitious, competitive, science grads and then lets them decide what kind of doctors they want to be at the end of their medical school career. So is it really surprising that most will choose ambitious, competitive, more technical fields (that is to say, well-remunerated subspecialties rather than poorly-remunerated primary care)?

In order to correct the problem of primary care doctor shortage medical schools need to either (a) change the composition of their student body so that the backgrounds and career aspirations of entering students correspond with a primary care speciality, or (b) have a quota system in which students commit to primary care prior to entering medical school. Filling such a quota would not be hard - like I said there are plenty people would be happy to family doctors - but medical schools would need to refocus their academic criteria for admission.